Tuesday, September 28, 2010

Is A Back Door Being Built For A Single Payer System?

That question is considered in the guest post that was provided below by a DMCB physician-colleague.......

From my perspective as a solo family doctor it looks that way to me.

I am seeing some disturbing changes in how physicians bill for their services, the rise of insurance mandates and increasing consolidation of the health insurance industry. Carried to their logical conclusion, the government will need to step in. Maybe that's the intent.

My daughter recently had an appointment with her pediatrician for a “well-child” visit. When I received a copy of the physician’s bill, I noticed that there was a fee for the well visit as well as for an intermediate acute visit (99213). This is important because my family insurance uses a high deductible policy. When I brought the possibility that there may be overbilling to the attention of physician’s office, they claimed it was well within coding guidelines.I didn’t agree, so I asked for a copy of the physician’s office note. This was enough to have my inquiry referred to the physician’s coding and compliance officer. After reviewing my daughter’s chart, he agreed that it did not meet requirements for a 99213 intermediate visit and informed me that the account would be credited.

This is more important than now being able to enjoy a night out with my spouse. That pediatrician’s practice was recently acquired by a hospital that is positioning itself to become an “Accountable Care Organization” (ACO). Before the hospital owned the pediatrician's practice, it was unheard of it to bundle a well and acute visit. But now, the hospital has apparently launched an aggressive coding initiative that is designed to maximize revenue. I predict that future ACO’s will find this and other ways to maximize revenue in ways that would have never been considered by well-meaning physicians and policy makers. This will increase costs.

Lastly, insurance company mergers and acquisitions have been commonplace in the last decade. If oligopolies occur (and by many accounts they already have) prices will go up and the government may be inclined to enact anti-trust protections, further increasing the involvement of government in health care.

Taken together, these developments and others may ultimately open up a back door for the single payer system. The combination of aggressive clinical billing, expanded disease coverage without universal coverage and insurance oligopolies may set the stage for increased government intervention backed by a frustrated voting public.

The most worrisome aspect is that the government may be as dumb as a fox. It is well known that the Obama Administration is enamored with increased federal involvement of healthcare. Between navigating the health care system for myself and my patients, watching the news and following the political dramas, it sure looks as if the stage has been set for the eventual passage of a single payer system.

7 comments:

I think it's obvious that a single payer system was the intent all along. Here is some interesting reading: http://www.capecodtoday.com/blogs/index.php/2010/03/23/3-step-process-to-single-payer-health-ca?blog=250

Ah, those devious Democrats! It's lucky that they've been caught out by right-thinking conspiracy theorists, and won't be able to pursue their foul plot of enacting health care reform legislation that's so hard for the public to understand that it will cause the loss of their Congressional majority and leave the Republicans with no choice but to pass single payer legislation.

Well said tongue in cheek, Roger. Maybe that's a key difference: those devious lefties are stumbling toward what they wanted all along, while those wackie rightists are trying every possible alternative until they get it right.

But seriously, isn't there some merit to the notion that the ACA was ultimately a road stop on the way to a single payer system all along?

If the foul plot that you are suggesting had existed, surely its evil schemers would have included a public option in PPACA. As it was, even with traditional Medicare as a model, the public option died--in committees controlled by Dems.

(Taking my tongue out of my cheek now) A more likely hidden agenda for PPACA is that described in Tom Daschles' book,"Critical," in which Daschle proposes an insurance exchange structure that's so successful that every purchaser of coverage wants to utilize it.

Having just reviewed Massachusetts' Connector experience (in www.reformupdate.blogspot.com), I'm not too optimistic that the PPACA exchanges will achieve Daschle's goal. (If a camel is a horse designed by a committee, what is PPACA?)

Your political positioning is starting to be exhausting; I admired your more functional presentations, but now it's all about your political views. Okay, now we know. Can you tame it down more objectively or is this where you intend to stay herein?

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About Jaan Sidorov MD, MHSA, FACP

While his web persona has been described as a "blogvocateur," Dr. Sidorov has wide range of knowledge about the medical home, condition management, population-based health care and managed care that is only exceeded by his modesty. He has been quoted by the Wall Street Journal, Consumer Reports and NPR’s All Things Considered.
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